新生儿及婴儿心脏直视手术后全球组织灌注与氧合评估。

Assessment of global tissue perfusion and oxygenation in neonates and infants after open-heart surgery.

作者信息

Gergely Mihály, Ablonczy László, Székely Edgár A, Sápi Erzsébet, Gál János, Szatmári András, Székely Andrea

机构信息

Department of Anesthesiology and Intensive Therapy, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary.

出版信息

Interact Cardiovasc Thorac Surg. 2014 Apr;18(4):426-31. doi: 10.1093/icvts/ivt537. Epub 2014 Jan 12.

DOI:10.1093/icvts/ivt537

PMID:24421206

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3957289/

Abstract

OBJECTIVES

Monitoring and preserving adequate perfusion and oxygen balance is a primary objective of critical care. This prospective observational study aimed to assess the relationship between global haemodynamic parameters and variables reflecting tissue oxygenation during the early period following corrective cardiac surgery in neonates and infants. The postoperative time course of oxygen delivery and consumption was evaluated. As surrogate markers of oxygen balance, the central venous oxygen saturation (ScvO2) and venoarterial PCO2 difference (PvaCO2) were thoroughly investigated.

METHODS

Thirteen children <1 year of age who underwent open-heart surgery were prospectively enrolled. In addition to conventional postoperative monitoring, transpulmonary thermodilution (TPTD) was used to monitor cardiac output and calculate oxygen delivery and consumption. In parallel with each TPTD measurement, arterial and central venous blood gas values were recorded. Global haemodynamic parameters and oxygenation measurements were compared with weighted linear regression statistics and Pearson's correlation coefficient.

RESULTS

Data from 145 TPTD measurements and 304 blood gas samples were recorded. The early postoperative period was characterized by a supply-dependent oxygen consumption, as demonstrated by the direct correlation between the change in oxygen delivery and consumption (r = 0.62, P < 0.001). Regarding haemodynamic parameters, none of the heart rate, mean arterial pressure or cardiac index correlated with the measured ScvO2. However, the ScvO2 and PvaCO2 were found to correlate significantly (r = -0.49, P < 0.001), and both strongly related to oxygen extraction.

CONCLUSIONS

Both the ScvO2 and PvaCO2 are reliable and comparable parameters in following tissue oxygen balance during the early postoperative course after open-heart surgery in neonates and infants. As part of multiparameter monitoring, our data highlight the importance of regular ScvO2 measurements and PvaCO2 calculations in paediatric intensive care.

摘要

目的

监测并维持充足的灌注和氧平衡是重症监护的主要目标。这项前瞻性观察性研究旨在评估新生儿和婴儿心脏矫正手术后早期整体血流动力学参数与反映组织氧合的变量之间的关系。评估了术后氧输送和消耗的时间进程。作为氧平衡的替代标志物，对中心静脉血氧饱和度（ScvO2）和静脉 - 动脉二氧化碳分压差（PvaCO2）进行了深入研究。

方法

前瞻性纳入了13名1岁以下接受心脏直视手术的儿童。除了常规的术后监测外，采用经肺热稀释法（TPTD）监测心输出量并计算氧输送和消耗。在每次TPTD测量的同时，记录动脉和中心静脉血气值。使用加权线性回归统计和Pearson相关系数比较整体血流动力学参数和氧合测量值。

结果

记录了145次TPTD测量数据和304份血气样本。术后早期的特点是氧消耗依赖于氧供应，氧输送和消耗的变化之间存在直接相关性（r = 0.62，P < 0.001）。关于血流动力学参数，心率、平均动脉压或心脏指数均与测得的ScvO2无相关性。然而，发现ScvO2和PvaCO2显著相关（r = -0.49，P < 0.001），且两者均与氧摄取密切相关。